BACKGROUND Patients requiring lung transplant for cystic fibrosis (CF) may require retransplant due to limited graft survival and otherwise excellent life expectancy. Optimal transplant strategy for this population, including single vs double lung retransplant, has not been established. METHODS We performed a retrospective analysis of the United Network for Organ Sharing/Organ Procurement and Transplant Network (UNOS/OPTN) database to identify adult lung retransplant recipients from 2005 to 2021 with a primary diagnosis of CF. Patients were stratified by retransplant type (single lung [re-SLTx] vs double lung [re-DLTx] retransplant). Descriptive statistics, Kaplan-Meier survival analysis, and multivariable Cox regression were performed. RESULTS From 2005 to 2021, 384 recipients underwent retransplant after an initial transplant for an indication of CF; more recipients underwent re-DLTx (N = 337 [87.8%]) than re-SLTx (N = 47 [12.2%]). The median (IQR) time from initial transplant to retransplant was similar between re-SLTx and re-DLTx recipients (4.4 [2.9-8.6] vs 4.6 [2.6-7.4] years, p = 0.73). Ischemic time was shorter and lung allocation score was lower for re-SLTx than re-DLTx recipients. Median survival after retransplant was significantly shorter for re-SLTx vs re-DLTx recipients (2.0 [95% CI 1.2-3.5] vs 4.3 [95% CI 3.5-6.1] years post-retransplant, p = 0.008). Median survival for adults with CF undergoing primary transplant for CF in the same period was 9.1 (8.5-9.9) years. After adjusting for donor and recipient characteristics, re-SLTx in patients with CF was associated with 88% higher hazard of mortality than re-DLTx (aHR=1.88 [95% CI 1.28-2.78], p = 0.001). CONCLUSIONS In this analysis of lung retransplant in recipients with CF, re-SLTx was associated with a higher hazard of mortality compared to re-DLTx, supporting re-DLTx as treatment for this population.

中文翻译：

---

囊性纤维化患者单肺再移植与双肺再移植的结果。


背景技术因囊性纤维化（CF）而需要肺移植的患者可能由于移植物存活有限和其他方面良好的预期寿命而需要再次移植。针对该人群的最佳移植策略，包括单肺再移植和双肺再移植，尚未确定。方法 我们对器官共享联合网络/器官采购和移植网络 (UNOS/OPTN) 数据库进行回顾性分析，以确定 2005 年至 2021 年初步诊断为 CF 的成人肺再移植受者。按再移植类型对患者进行分层（单肺 [re-SLTx] 与双肺 [re-DLTx] 再移植）。进行了描述性统计、Kaplan-Meier 生存分析和多变量 Cox 回归。结果 从 2005 年到 2021 年，384 名受者在初次移植后因 CF 指征接受了再次移植；接受 re-DLTx 的接受者 (N = 337 [87.8%]) 多于 re-SLTx (N = 47 [12.2%])。 re-SLTx 和 re-DLTx 受者之间从初次移植到再次移植的中位时间 (IQR) 相似（4.4 [2.9-8.6] vs 4.6 [2.6-7.4] 年，p = 0.73）。与重新 DLTx 接受者相比，重新 SLTx 的缺血时间更短，肺分配评分更低。 re-SLTx 与 re-DLTx 受者相比，再移植后的中位生存期显着缩短（再移植后 2.0 [95% CI 1.2-3.5] vs 4.3 [95% CI 3.5-6.1] 年，p = 0.008）。同期接受 CF 初次移植的成人 CF 患者的中位生存期为 9.1 (8.5-9.9) 年。调整供体和受体特征后，CF 患者的 re-SLTx 死亡率风险比 re-DLTx 高 88%（aHR=1.88 [95% CI 1.28-2.78]，p = 0.001）。 结论 在对 CF 受者肺再移植的分析中，与 re-DLTx 相比，re-SLTx 与更高的死亡风险相关，支持 re-DLTx 作为该人群的治疗方法。